The use of antibiotics in the United States

posted 3 years ago in Wellness
Post # 3
Member
42538 posts
Honey Beekeeper
  • Wedding: November 1999

@MichiganGirl24:  I agree that the public needs educating about the misuse of antibiotics, but the people who need it most are doctors. They are the ones who over prescribe antibiotics. The general public can’t use them unless they are given a prescription.

I have discussed this with doctors i work with in the ER. Their excuse is that if they don’t give someone an Rx, they will go see another doctor and get it from them. This is ridiculous!

Doctors don’t hand out narcotic prescriptions to anyone who asks, just so they don’t gp somewhere else to get one.

Yes the public can be demanding and want prescriptions for vital illnesses. But it is up to he doctors who have the education to know the difference to JUST SAY NO!

Post # 5
Member
779 posts
Busy bee
  • Wedding: September 2011

I just read this article earlier this morning! Horribly frightening stuff.

And yes, many doctors overprescribe antibiotics, but the real problem IMO is with livestock. 80% of our antibiotics go to livestock so that factory farming corporations like Smithfield can continue producing as much meat as cheaply as possible. As if environmental degredation, contributing to a whole host of medical problems (cancer, obesity, heart disease, you name it), and gratuitous animal cruelty weren’t bad enough. But hey, silver lining–the impending apocalypse should more or less resolve the problem of how we’re going to pay for all those retiring baby boomers.

Post # 7
Member
779 posts
Busy bee
  • Wedding: September 2011

@MichiganGirl24:  If only! It’s hard to imagine meaningful restrictions on lobbying or campaign finance being passed, but until they do I doubt much will change.

Post # 8
Member
4656 posts
Honey bee
  • Wedding: January 2014

Good article. Thanks.

Post # 9
Member
3210 posts
Sugar bee
  • Wedding: January 2014

Really interesting! My grandma nearly died of sepsis after contracting VRE in her kidneys–amazingly, she’s made a full recovery, but it was interesting to see VRE mentioned here!

Post # 10
Member
33 posts
Newbee
  • Wedding: October 2011

@julies1949:  

@MichiganGirl24:  

 

I think you would be hard pressed to find more than a handful of doctors who are not aware of the issue of over-prescribed antibiotics and the damage it does. I think most physicians are extremely aware of it and concerned. But there are opposing forces at work here. 

When I was in med school and working in the ER one night a kid came in with a viral illness. Nothing to suggest a bacterial infection. The mom was insistant the the kid needed antibiotics (abx) and I explained in detail why but she definitely didn’t believe it. I presented the kid to the attending who also agreed that no abx were needed and I was horrified when he gave her an Rx for some. When I questioned him, he basically told me it wasn’t worth the fight. There were 10 other patients he was seeing, he could spend 20 minutes with her and she wouldn’t believe him either and would just go to a different ER until someone gave her what she wanted. At that point I decided he was just being lazy, and maybe he was, but later on I realized there was some truth in what he was saying. 

As a general peds resident, I was amazed that there are a decent number of parents (definitely not all) who are very insistant on abx for their kids. You can explain till you are blue in the face that the illness is from a virus and abx don’t have any effect on virus and the child is more likely to develop side effects from abx than actually help the infection. Some would come around, but a fair number wouldn’t budge since they know things like “yellow/green/thick mucous” means a bacterial infection, white spots in the back of the throat are definitely strep troat (which made an appearance on this board last week) and a hacky cough is pneumonia. These are things people grew up hearing and sometimes are very deepy held convictions. In the era of 10-15 min appts it’s just not possible to educate people about things they don’t want to hear or it would take an hour of your time and they want you to call Aunt Myrtle who says the kid needs the abx and convince her too. They then proclaim you a terrible doctor and then go to an urgicare and get abx if you refuse. It’s a lose-lose situation. Compounded with the fact that doctors are now often rated in terms of patient satisfaction, denying abx to an angry parent may wind up working against you. Sometimes bad medicine = good satisfaction scores = happy hospital and administration. I wish it weren’t true but it’s how it works at times. 

 

Even last week my own sister was about to start a z-pak for 3 days of congestion and a cough. What? Um, no. But it’s a lot easier for me to convince my sister to hold off on the Z-pak than for doctor in urgent care to convince a patient he is meeting for the first time. 

 

I’m exceedingly happy I’m not in a peds specialty that has to deal with prescribing antibiotics on a regular basis because it’s an ongoing fight. But if it’s not abx it’s something else. My friend who does adult urgent medicine has to deal with people coming for head CT’s ever since all the football-related head injury stuff was all over the news. People ask me for colonoscopies for constipation but when you get into the more invasive stuff, it’s a lot easier to refuse since most parents don’t really want their 10 year old to get a scope. 

 

I agree that the problem of antibiotic overuse is growing tremendously and we are definitely seeing lots of bad new bugs with stronger resistance patterns. It’s scary stuff. I tend to think education is the only way out of this mess along with the livestock issue, but education isn’t always a priority in this country. 

Post # 11
Member
42538 posts
Honey Beekeeper
  • Wedding: November 1999

@chauliodus:  That’s a total cop out on the part of the doctors. If a suspected drug abusing patient wants narcotics, the doctors don’t spend 15-20 minutes talking them out of it and explaining why they aren’t necessary. They tell them “I’m not prescribing narcotics”, turn their back and walk away.

In Canada doctors have to use triplicate prescriptions for narcotics so their prescribing practice can be audited. I think maybe it’s time to do the same for antibiotics.

Post # 12
Member
33 posts
Newbee
  • Wedding: October 2011

@julies1949:

It’s far easier (but not right) to walk away from a narcotic abuser and not give narcotics, but a far different task to walk away to a parent who is crying and worried about their kid. Regardless, I think it would be rather shitty to just turn your back on an addict and say I’m not giving you narcotics and walk away. I think everyone deserves a conversation with their doctor. 

If you were worried about your thyroid, felt very strongly about it and really wanted testing and your doctor just said no and walked out, I don’t think most people would be ok with that even if it’s the right thing to do medically. 

Do I think it’s right or justified that so many abx get Rx’ed? Absolutely not. But it may seem black and white on paper, but the way medicine plays out in the real world is a lot more complicated. We have to see certain numbers of patients in short amounts of time and have good satisfaction scores. You think it’s ridiculous, but there are different pressures at work.

 

Post # 13
Member
3557 posts
Sugar bee
  • Wedding: August 2014

@chauliodus:  I’m a biochemist who specializes in mycology (fungi for those not up on the lingo, the source of many of our antibiotics). I went to a walk-in clinic with a week and a half long fever + other symptoms and the doctor was pretty sure it was viral and that there wasn’t much they could do. They started explaining to me that they weren’t going to give me antibiotics and seem both relieved and taken-a-back when I said ‘why would you give me antibiotics for a virus, it’s not like it would do anything?’ I find it sad that the doctor was suprised at my reaction. I feel like this is something we should be teaching in 10th grade biology: antibiotics are for bacteria, anti-virals are for viruses. It’s something that seems like it should be common knowledge, but it’s really not.

Post # 14
Member
42538 posts
Honey Beekeeper
  • Wedding: November 1999

@chauliodus

Not to worry- everyone gets a proper assessment and a conversation with their doctor. I’m sure you know that. There does come a point however, when doctors do have to say to drug seekers- “I am not going to prescribe narcotics.” They are most often offered detox, other meds etc that will help them while they withdraw etc.

I work in the ER so I know all about the pressures. Doctors can make all the excuses they want, but they are the ones over- prescribing antibiotics and they are not teaching parents anything by writing said prescriptions. The parents’ determination that the child needs antibiotics is simply reinforced.

Post # 15
Member
63 posts
Worker bee
  • Wedding: September 2013

Antimicrobial resistance is scary. I work in a pathology lab attached to a major hospital. More specifically, I work in Microbiology, where we grow up pathogens from patient specimens and perform animicrobial suceptibility testing to determine what antibiotics they are sensitive/resistant to. It is scary that in the time I have been working there (7 and a half years) how much antibiotic resitance has increased. Things like VRE have gone from being almost never seen, to around 1 case a week, and MRSA is common now. If the levels of drug resistance can increase that much in just a few years, what are things going to be like in 30 years?

We have recently changed our antibiotic reporting guidelines to help combat the inappropriate use of certain antibiotics by doctors. This means that while we test a whole variety of antibiotics, we only report a selection to stop certain drugs being used unnecessarily.

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